How many people in this country haven’t had their blood cholesterol level tested? Or had their doctor suggest a stress test or electrocardiogram to evaluate the risk of heart disease? I doubt that many have escaped some of these tests.

Dr. W. Gifford-Jones

How many people in this country haven’t had their blood cholesterol level tested? Or had their doctor suggest a stress test or electrocardiogram to evaluate the risk of heart disease? I doubt that many have escaped some of these tests. But has your doctor ever said, “I want to measure the length of your legs?” Or examined your ear lobe? These are examples of the KISS principle: “Keep it simple, stupid.”

Dr. Kate Tilling reports an interesting finding in the American Journal of Epidemiology. Tilling and her colleagues at Bristol University in the U.K. measured the leg lengths of 12,252 men and women aged 44 to 65. They discovered the longer the leg, the less risk of heart attack and stroke.

But how does the length of leg determine the chance of these diseases? We know that if a coronary artery is narrowed due to cholesterol deposits (atherosclerosis), there’s greater risk of a blood clot forming and possible heart attack.

Dr. Tilling discovered that people with longer legs showed less buildup of cholesterol deposits in both the heart’s coronary arteries and the carotid vessels that supply blood to the brain. And with less hardening of arteries, there was less risk of either heart attack or stroke.

The $64 question, then, is why do some people have longer legs? Certainly having parents with long legs is a big advantage. But Tilling claims that leg length is strongly affected by habits established early in life.

For example, studies have linked breast feeding and high-energy diets between the ages of two to four years to increased leg length. It also helps to be born into an affluent family where better nutrition is practiced. And this may also be the reason why these same people have less atherosclerosis.

I realize that simple tests like leg length are not the be-all-and-end-all in determining who develops heart disease. But today doctors get so caught up in ordering expensive tests that it’s worthwhile now and then to stress that technology is not always the only determinant of who dies from these diseases. You can have a normal electrocardiogram test one day and be dead the next.

The utilization of these KISS tests during a checkup can help to pinpoint who is headed for a cardiovascular problem. And then it can be stressed to patients that lifestyle changes can decrease the risk of this happening.

For example, we know that many people don’t take the belly measurement seriously. They forget that not all fat is created equal. As in real estate sales, you’re a winner or a loser depending on location. And for risk of cardiovascular disease, you’re a loser if fat is located in the belly.

So again, another simple test. Dr Salim Yusuf, of McMaster University in Hamilton, Ontario, says the best indicator of heart attack risk is the waist-to-hip ratio. The best ratio is when the waist is smaller than the hips. Being pear-shaped is much better than being apple-shaped.

Dr. Jean-Pierre Despres, professor of human nutrition at Laval University in Quebec City, goes even further reporting that a waistline of more than 100 centimeters (40 inches) for men and 90 centimeters (35 inches) for women is a risk factor for heart disease.

Yet another Kiss test is the “ear lobe crease.” It too can help to pinpoint heart disease. If the crease starts where the ear lobe attaches to the head, angles backwards towards the lower edge of the ear and is quite obvious, it can be a signal.

Dr. William Elliott, at the University of Chicago, examined 1,000 patients suffering from coronary heart disease. He discovered that patients with this crease were much more likely to suffer from heart disease.

Another study at the Mayo Clinic showed that 90 percent of patients complaining of chest pain who also had an earlobe crease were having a heart attack. But only 10 percent of those with chest pain without the crease were experiencing coronary problems.

So the message is simple. Short legs, big bellies and an earlobe crease belie an increased risk of cardiovascular problems. You can’t change the length of your legs or the earlobe crease. But you can decrease the size of your belly.

See the Web site www.mydoctor.ca/gifford-jones

Dr. W. Gifford-Jones is actually Dr. Ken Walker, a practicing physician in Toronto who writes many columns at his Bristol Harbour residence.